Friday, March 27, 2020

The Odd Hospital Bed Shortage in New York City

As COVID-19 hits New York City with the brunt of its force, mainstream media has begun its onslaught of reports that the virus will overwhelm the city's hospitals.

The problem with this reporting is that neither mainstream media nor hospital administrators have a good track record when presenting reality.

And this: THE BIG SCAM: Understanding How Hospitals Price Individuals Versus Healthcare Insurance Companies.

From there, the problem gets worse because there is absolutely zero data being released that would provide information to independently analyze the situation.

We know that the number of hospital beds in New York City, depending upon the source, is somewhere between 20,000 and 25,000. But that is all the data that is generally available.

There is no data that I was able to find, for example, that lists how many patients are currently in the hospital because of the flu or the number that are admitted for flu over the flu season.

Indeed, there is no breakdown as to what type of patients take up hospital beds.

Although we get a daily announcement as to how many new "confirmed" cases of those infected with COVID-19, there is no breakdown of how many of those are hospitalized and the severity of their cases.

In other words, it is impossible to put the current situation into perspective in terms of what is different from routine flu or anything else that might cause people to end up in a hospital.

Finally, hospitals appear to run pretty much on a full occupancy basis. It would be interesting to understand what government regulations and funding incentives create this situation. Keep in mind that government regulations appear to be at the epicenter of the mask shortage.

A full hospital occupancy policy, which appears to be more of the situation than even for hotels, is odd when you would think that hospitals would in a free market have the ability to expand capacity rapidly for emergencies.

I, for one, can think of a number of options that would immediately improve the capacity situation that aren't being used by NYC hospitals at present.

Bottom line: It is impossible to understand what kind of an extreme outlier COVID-19 is for the New York City hospital industry, if at all, given that reports are coming from two sources that must be questioned as to their veracity and, at the same time, the data necessary to independently analyze the situation is not readily available.

There is definitely the potential for a PhD paper in applied economic policy concerning the structure of New York City hospitals and their ability to react to the COVID-19 panic. I smell crony government bureaucratic central planning and a lot of it.




    1. And New York was the first state to pass a CON law, in 1964! F&ck hospitals. We are putting millions out of work to protect their crony deals with state and federal governments. We have to flatten the curve because they flattened the supply curve. They can go to Hell.

  2. Last summer I was advised by a walk in clinic to go to the ER for an illness, and from there they decided it would be best to be admitted to the hospital for the night.

    In the meantime I stayed in an ER suite for about four hours while they waited for a room to become available. (Incidentally, aside from not having a bathroom, the suite basically seemed the same as the hospital room.)

    Anyway, at one point a nurse came in and apologized for the wait, and then in passing mentioned that this wasn't usually a problem before they decided to go with one bed per room. Since the nurse was pretty young I got the impression that this decision had been made fairly recently.

    That was the only time I had ever had to stay at a hospital so I don't have anything to compare that experience with, but from what I could gather two beds could have easily fit in both the ER and hospital room.

    I never put much thought into until now, but at least for that particular hospital it seems as though they at least have the space to more than double their capacity for beds if you include the ER. I'm not sure what the ICU situation is since my condition wasn't serious enough for that.

  3. Speaking as a physician who has worked in numerous inpatient settings, the incentives for filling and keeping full hospital beds are pretty screwed up. It is very different from a hotel, and probably more akin to a prison system, at least based on my understanding of prisons. This boils down to the fact that third party pay or systems are involved, and most patients are not truly in control of their length of stay.

    For people with insurance, within 24 hours of admission a tentative medical diagnosis is made, and the insurance company grants a number of days that they will pay for to address that diagnosis. For example, if the admission diagnosis is bacterial pneumonia, they will look at their average length of stay historically for that diagnosis, perhaps 5 days, and then grant a 5-day approval. On the fourth or fifth day, the case will be reviewed by the insurance company and more days can be added if the patient is not ready to be discharged or if new problems have been identified. The hospital has every incentive to use every single one of those initial, approved 5 days, even if the patient gets better in 3 days. It also has every reason to find other things wrong that will extend the stay longer, even if such things are mild or do not warrant hospitalization. Ultimately it is the physician who makes the call for admission and discharge, and most try to do the right thing, but we are under tremendous pressure from administration to extend the stay of those who have insurance and shorten the stay of those who do not. I am obviously only scratching the surface here, but you get the idea.

    Incidentally, in a VA hospital, the incentives are totally different. All admissions have “coverage” so the incentive is to push for the shortest stay, even to a fault.